Telehealth Intervention by Pharmacists Collaboratively Enhances Hypertension Management and Outcomes

ABSTRACT

Objective: To evaluate the impact of a centralized pharmacist-led telehealth model utilizing home blood pressure monitoring (HBPM) readings on hypertension quality measure pass rates and blood pressure reduction at 3 and 6 months.

Study Design: Retrospective observational cohort study.

Methods: Adults with uncontrolled hypertension (≥ 140/90 mm Hg) were identified through a centralized outreach model. Patients who completed a visit with a pharmacist comprised the intervention group; those who were not reached or who declined were included in the usual care group. Pharmacists met with patients via telehealth appointments and sent recommendations to their providers.

Results: A total of 1776 patients were included: 179 patients in the intervention group and 1597 patients in usual care. The mean age was 56 years (95% CI, 55.7-57.0 years), with approximately half identifying as female (47.6%-53.1%). The intervention group had a higher proportion of Black patients (53.1% vs 37.3%; P = .0002) and a higher mean Elixhauser Comorbidity Index score (2.93 vs 2.54; P = .0016). Patients in the pharmacist intervention group were more likely to pass the Healthcare Effectiveness Data and Information Set Controlling Blood Pressure measure (2022: OR, 1.78; P = .014; 2023: OR, 1.75; P = .014). Greater systolic blood pressure reductions in the intervention group vs usual care were observed at both 3 months (–12.69 vs –5.69 mm Hg; P < .0001) and 6 months (–13.87 vs –9.05 mm Hg; P = .001).

Conclusions: Participating in telehealth visits integrating HBPM readings with a pharmacist between primary care visits significantly improves blood pressure control. Pharmacists play a critical role in actively engaging patients and optimizing medication therapy in team-based care for chronic hypertension management.

Am J Manag Care. 2026;32(1):In Press

Takeaway Points

Leveraging telehealth visits and home blood pressure monitoring (HBPM), clinical pharmacists at our institution improved blood pressure control and quality measure performance, demonstrating a scalable value-based care model.

• Patients who engaged with pharmacists were significantly more likely to pass the Healthcare Effectiveness Data and Information Set Controlling High Blood Pressure measure.
• Systolic blood pressure reductions at 3 and 6 months highlight the potential to reduce long-term cardiovascular risk.
• These findings support payer-based incentives and showcase the real-world impact of pharmacists as essential partners in chronic hypertension management and delivery of health care.

Blood pressure (BP) control remains a priority for health systems, particularly those adopting value-based care. Innovative strategies are critical for reducing cardiovascular risk, as heart disease and stroke are the leading causes of mortality in the US.^1,2 A reduction of 10 mm Hg in systolic BP lowers cardiovascular event risk and reduces all-cause mortality by 13%.³

The Healthcare Effectiveness Data and Information Set (HEDIS) Controlling High Blood Pressure (CBP) measure evaluates the proportion of patients whose BP is controlled in the population. Passing this measure is defined as “The percentage of members 18 to 85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled [< 140/90 mm Hg] during the measurement year.”⁴ In 2022, CBP control rates averaged 54.9% to 63.8% (commercial) and 70.2% to 72.9% (Medicare).⁵ This program and research aimed to collaboratively improve BP given its clinical and financial significance.

University of North Carolina (UNC) Health has established population health management services designed to deliver comprehensive, efficient care to patients in the health care system. UNC Health’s population health services include the Carolina Assessment of Medications Program (CAMP), staffed by 4 residency-trained pharmacists and 6 certified pharmacy technicians. During the study period, the CBP measure support accounted for less than 5% of the team’s total support of multiple quality measures and value-based care contracts. The team collaborates with patients and providers to optimize medication use, access, and education to improve health outcomes and cost of care. Prior CAMP clinic analysis showed a $388.50 per-patient monthly cost reduction.⁶ In this study, we evaluate the performance of a single quality measure.

To expand care access and improve BP control, CAMP implemented a hypertension program utilizing home blood pressure monitoring (HBPM) as a key strategy. HBPM is recommended by the US Preventive Services Task Force for confirming hypertension and by the American College of Cardiology/American Heart Association for diagnosis, medication titration, and managing white coat hypertension and masked hypertension.^7,8 HBPM is also supported as part of team-based and telehealth care.⁸ In 2021, a national insurer in the state recognized HBPM as equivalent to office BP readings. In response, CAMP launched a telehealth initiative to improve CBP performance by improving BP control and documenting HBPM in the electronic health record (EHR).

The objectives of the pharmacist-led CAMP hypertension program were to evaluate the impact of a centralized pharmacist-led telehealth model utilizing HBPM readings on CBP quality measure pass rates for 2022 and 2023 and overall BP reduction at 3 and 6 months.

METHODS

This retrospective observational cohort study took place within the CAMP clinic at UNC Health and was deemed non–human subjects research by the UNC Institutional Review Board (#23-1768).

The Figure outlines the CAMP workflow. Eligible patients were 18 years and older, had health benefits through the target insurer, and were at risk of failing the CBP measure, defined as having no BP recorded in the measurement year or a most recent BP that was at least 140/90 mm Hg. When available, average BP readings were used to identify patterns of uncontrolled hypertension. Exclusion criteria included residence outside North Carolina or no primary care visit within the past 18 months. Eligible patients were identified via EHR reports and included different insurance types (commercial, Marketplace, and Medicare Advantage). Patients could also be referred directly by care team members. Referring providers were notified if patients were deemed ineligible. CAMP services were promoted to providers alongside systemwide efforts to improve HBPM documentation.

Certified pharmacy technicians conducted outreach through mailed letters and EHR outreach, followed by 2 phone call attempts. The CAMP-enrolled cohort included patients who accepted the service and completed at least 1 telehealth visit with a pharmacist. The usual care cohort consisted of eligible patients who either declined participation or did not respond to outreach efforts. This analysis included patients with an initial outreach or visit between January 1, 2022, and December 31, 2023.

During telehealth visits, pharmacists assessed medication adherence, tolerability, affordability, and patient-reported home BP readings, which were then documented in the EHR. The pharmacists verbally assessed the patient’s HBPM technique and provided appropriate coaching at the initial visit and as needed thereafter. As shown in the Figure, pharmacists collaborated with the primary provider until the patient’s treatment goals were achieved or the patient withdrew. Visit frequency and timing varied based on the patient’s individual needs. Providers received recommendations from the pharmacist (eg, dose adjustments, laboratory orders). The pharmacist then contacted the patient to communicate approved changes, when applicable. Pharmacists tracked recommendations within the EHR, categorizing them using the Pharmacy Quality Alliance’s Medication Therapy Problem Framework.⁹ Patients in the usual care cohort saw their providers on their usual schedule and had no interactions with the virtual pharmacist team.

For the primary study objective, passing the HEDIS CBP measure was defined in the data set as the last reported BP of the calendar year, less than 140 mm Hg systolic and less than 90 mm Hg diastolic. The secondary objective was to evaluate the change in BP from baseline (preintervention) to 3 months after the initial visit with CAMP and 6 months after the last CAMP visit (post intervention) compared with the usual care group.

To more closely approximate the HEDIS specifications outlined in the technical manual, BP values associated with procedural visits (eg, surgeries, infusions), emergency/urgent care visits, and hospital admissions were removed from the data set for both primary and secondary objectives.⁵ Only data available within UNC Health’s EHR were available for analysis. Data for BP values, demographics, body mass index (BMI), and problem list diagnoses were pulled from UNC Health’s data warehouse. Values for Social Vulnerability Index (SVI) exist within the warehouse; any missing SVI data were cross-referenced with values available from the CDC Agency for Toxic Substances and Disease Registry 2022 public databases and updated manually in the data set.¹⁰

Statistical Analysis

Baseline differences were assessed using t tests and Wilcoxon tests. To evaluate the effect of the intervention on the primary outcome of the BP pass/fail measure, a logistic model was used to adjust for BMI, SVI, sex, age at initial visit, and ethnicity as confounders.

A mixed model approach was used to assess changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 3 months and 6 months. To further validate these findings and to assess the presence of a time-by-intervention interaction effect, a difference-in-difference (DID) analysis was conducted. A post hoc analysis was also completed for racial differences in the primary and secondary outcomes.

RESULTS

Baseline Characteristics

A total of 1776 patients met the inclusion criteria: 1597 in the usual care group (nonresponders and those who declined) and 179 in the CAMP-enrolled group (≥ 1 pharmacist telehealth visit). Patients referred to this service accounted for a small portion of patients. Twelve patients in the CAMP group (6.7%) and 5 patients in the usual care group (0.3%) were referred by a provider. Most patients were aged 18 to 64 years, consistent with a commercially insured population. Baseline characteristics were similar, except for a higher proportion of Black patients in the CAMP-enrolled group than the usual care group (53.1% vs 37.3%; P = .0002) and a higher mean Elixhauser Comorbidity Index score (2.93 vs 2.54; P = .0016) (Table 1).

Study Outcomes

For the primary outcome, 1604 patients were included in the statistical analysis after accounting for missing confounders in the logistic model (2022: n = 657; 2023: n = 947). Across both years, patients in the CAMP-enrolled group demonstrated significantly higher odds of passing the HEDIS CBP measure compared with the usual care group (2022: OR, 1.78; P = .014; 2023: OR, 1.75; P = .014) (Table 2).

For the secondary outcome, 1764 patients were analyzed using a mixed model to evaluate changes in SBP and DBP from baseline to 3 and 6 months. Baseline SBP exceeded 140 mm Hg in both groups with no significant difference (151.7 vs 150.4; P = .26) (Table 3). The CAMP-enrolled group achieved significantly greater reductions in mean BP at both points across all measures compared with the usual care group. For the change in SBP from baseline, the CAMP-enrolled group achieved significantly greater reductions at 3 months (–12.7 vs –5.7 mm Hg; P < .001) and 6 months (–13.9 vs –9.1 mm Hg; P = .001) compared with the usual care group (Table 3). Finally, reductions in DBP were also significantly greater in the CAMP-enrolled group at both 3 months (–5.7 vs –2.3 mm Hg; P < .001) and 6 months (–6.4 vs –3.7 mm Hg; P = .008) (eAppendix Table 1 [eAppendix available at ajmc.com]). Additionally, the DID analysis showed that the effect of the intervention significantly reduced SBP, and the impact of the intervention was sustained over time (eAppendix Table 2).

Pharmacist Interventions

CAMP-enrolled patients had a mean of 2.93 visits with pharmacists, who made a total of 472 medication-related therapy interventions. The majority of these interventions addressed medication effectiveness (49.4%), followed by adherence (32.6%), safety (16.1%), and indication (1.9%). Among effectiveness-related interventions, HBPM was the most frequently recommended strategy (56.7%), followed by medication optimization (31%) and recommending a laboratory test (11.9%). HBPM recommendations were also commonly integrated into adherence and safety interventions. For adherence-related interventions, the most frequent recommendations were patient education (65.8%), medication optimization (20.1%), and cost-saving strategies (10.7%). Safety-related interventions primarily involved medication optimization (52.5%), recommending a laboratory test (25.4%), and patient education (15.3%). For indication-related interventions, the top recommendation included medication optimization (75%). Notably, across all intervention categories, medication optimization emerged as a unifying strategy, demonstrating consistently high rates of implementation and acceptance by providers (90.3%) (Table 4).

Racial Differences

eAppendix Tables 3 through 5 display the post hoc analysis of racial differences observed for BP differences for primary and secondary outcomes. In 2023, Black patients had significantly lower odds of meeting the HEDIS CBP measure compared with White patients, with approximately 6 Black patients passing the measure for every 10 White patients (OR, 0.56; 95% CI, 0.40-0.78; P = .003) (eAppendix Table 4). For secondary outcomes, Black patients had significantly higher SBP at both 3 months (point estimate, 4.20; 95% CI, 2.20-6.19; P < .0001) and 6 months (point estimate, 4.69; 95% CI, 2.59-6.79; P < .0001), indicating poorer control at both time points compared with White patients (eAppendix Table 5).

DISCUSSION

Patients who engaged in the pharmacist-led telehealth visits using HBPM between primary care visits achieved sustained improvements in BP control compared with usual care. This provides value to patients, providers, and the health care system. HBPM offers reliable and cost-effective data over time, can confirm white coat hypertension, and supports clinical decision-making.¹¹ Access to these data during telehealth visits enabled pharmacists to optimize therapy and support patients in achieving BP goals. A retrospective review of pharmacists engaged in chronic care management services, in which patients also must agree to participate, showed a mean decrease in SBP from 141 to 130.3 mm Hg.¹² A different retrospective study with remote pharmacists within Veterans Affairs clinics also showed a decrease in BP (mean of 159/89 mm Hg to 133/78 mm Hg).¹³ These findings align with prior evidence showing that pharmacist-led telehealth services using HBPM significantly improve BP outcomes.^14,15 Although these and other studies showcase the positive benefit of pharmacists working under collaborative practice agreements that grant prescriptive authority, this program achieved similar lowering of BP by working in a usual scope of pharmacy practice and providing recommendations for prescribers to act. This is important because some states or organizations may not have fully implemented advanced practice models that enable pharmacists to have prescriptive authority.

Primary care is evolving, with increased emphasis on guideline-directed care and outcomes-based payment models. Providers face challenges in providing all the necessary patient care within the clinic visit.¹⁶ Compounding this, patients frequently struggle to implement the care plan independently. Following a primary care visit, up to 30% of patients fail to fill prescriptions, 50% of those who do fill their prescriptions take them incorrectly, 62% face confusion about their care following an office visit, and 31% forget the medical information provided; all these lead to patients often returning in worse condition.¹⁷ Pharmacists, who are uniquely educated and positioned within the care team, address these gaps by helping patients understand their conditions and medications, supporting adherence strategies, and empowering them to implement care plans that include HBPM effectively. Through telehealth, pharmacists work collaboratively with patients in low-stress environments, facilitating shared decision-making and offering personalized support. Pharmacists are also able to have more frequent touchpoints with patients compared with traditional provider visits in most cases. By tailoring regimens and addressing barriers, pharmacists minimize unnecessary follow-up messages and contribute to clinical goal achievement. Although our study did not directly measure provider follow-up burden, the faster and sustained BP control observed in the CAMP-enrolled group suggests a reduced need for additional provider visits or provider-patient communications due to therapeutic inertia or care plan confusion.

Nearly 82% of interventions targeted regimen effectiveness and adherence barriers, often resolved directly with patients through education, coaching, and active listening during the telehealth visits. Patients actively engaged in their care by monitoring BP at home and sharing readings and experiences with the pharmacist. When therapy adjustments were needed, pharmacists provided clear, actionable recommendations in visit documentation, allowing primary care providers to make efficient, low-burden decisions. Unlike some CAMP services that leverage prescriptive authority through collaborative practice agreements, this model does not, thereby enhancing its applicability to broader population health efforts. Regardless of care model, pharmacists’ clinical expertise and ability to assess therapeutic nuance, address barriers, and tailor strategies make them essential contributors to improving hypertension outcomes.

This service shows significant clinical and financial value. Patients in the CAMP-enrolled arm had a greater likelihood of achieving BP control (OR, 1.75-1.78). They experienced clinically meaningful SBP reductions (12.69 mm Hg at 3 months and 13.87 mm Hg at 6 months), translating to long-term cardiovascular benefits. These outcomes contribute to improved performance and incentive eligibility in advanced payment models within our health system. Long-term modeling suggests an overall cost avoidance of $10,162 per patient over 30 years, resulting from reduced cardiovascular events when pharmacists collaborate to optimize hypertension regimens.¹⁸

Our service also demonstrated the value of telehealth to patients in general primary care. Data show that patients are open to receiving telehealth services from pharmacy teams, with 69.9% agreeable to medication counseling and 27.1% to chronic disease management.¹⁹ Because our service was mostly designed around unscheduled prospective recruitment calls to eligible patients, one might expect low participation rates due to patients’ unfamiliarity with our service or the potential lack of an HBPM device. Compared with other population health management services utilizing “cold call” recruitment strategies within our system, our program’s engagement rate is in line with the typical range of 10% to 53%. Although the overall program engagement rate was low within the standard range of recruitment, other ways to increase engagement could include obtaining funding for supplying BP monitors to patients, as those who did not have a monitor often declined the service.¹⁵

Limitations

Key limitations of this study are the imbalance between the usual care and CAMP-enrolled groups due to the opt-in design of the program and retrospective trial design, which could introduce selection bias. Patients who choose to participate may generally be more engaged in their care and predisposed to better outcomes. Additionally, we could not independently verify the accuracy of home BP readings, as all visits with the pharmacist were conducted remotely. However, pharmacists did provide verbal instruction on proper monitoring techniques and encouraged patients to bring their devices to in-person provider visits for validation.

Although only data within our hospital system were utilized to assess passing rates of the HEDIS CBP measure, if a BP reading outside our system was obtained and submitted to a payer and acted as the final reading for the measurement year, then we were unable to reconcile these BP readings into our passing score percentages for the groups. We believe such instances represent a small proportion of the overall cohort, as our study population was intentionally limited to primary care patients actively managed within our health system.

Building relationships virtually, with approximately 1300 primary care providers spread across the state and their patients, is challenging for CAMP’s small team of 4 full-time equivalent clinical staff pharmacists and 6 certified pharmacy technicians covering multiple value-based care contracts and quality measures within UNC Health. This can contribute to patient and provider hesitancy in accepting our service or being unaware of our offerings, as evidenced by the 10% enrollment rate for this service. Internal marketing to providers is an ongoing strategy, and digital patient outreach options such as texting and messaging through the EHR have helped associate our work as a service offered through the health system.

Future Directions

Interestingly, we observed an unexpected and notable increased proportion of patients in the treatment arm who identify as Black (53.1% in the treatment arm vs 37.3% in the usual care arm) (Table 1). Although fewer Black patients passed the HEDIS CBP measure compared with White patients (OR, 0.56; 95% CI, 0.40-0.78; P = .003) (eAppendix Table 4), and our pass rates were lower than the national average,²⁰ there is opportunity to further close health disparity gaps by addressing a broader range of contributing factors.²¹ Our team is currently involved in a prospective, multiyear project²² to address this disparity more specifically.

CONCLUSIONS

This study demonstrates that a centralized, pharmacist-led telehealth model can significantly improve BP control compared with usual care by optimizing medication therapy plans and patient comprehension between traditional office visits. The program’s unexpected success in engaging Black patients suggests that pharmacist-led telehealth could be a promising strategy to improve equity in hypertension management, helping to fill a critical gap in chronic hypertension management.

Importantly, this model underscores the value of HBPM as a critical tool for timely assessment and intervention. Integrating home BP readings into clinical workflows not only strengthens longitudinal hypertension management but also empowers patients and supports more accurate performance measurement.

The CAMP clinic’s real-world impact of achieving meaningful SBP reductions and higher HEDIS CBP pass rates potentially reduces long-term cardiovascular risk and enhances performance under outcomes-based payment models. These findings support broader integration of clinical pharmacists into population health strategies and offer a scalable, cost-avoiding intervention for health systems navigating primary care reform and value-based contracting.

Acknowledgments

The authors acknowledge Resham Basnet, MBBS, MPH, for pulling the data set for this study; Rebecca Brady, PharmD, for her work in building the workflows and managing the program; the UNC Health Population Health Solutions team for helping build the initial report for patient identification; Whitney Conlon, MS, for her support of workflow data visualization; and CAMP pharmacy technicians and pharmacists for their contributions to patient recruitment, engagement, and care delivery.

Author Affiliations: Managed Pharmacy Solutions, UNC Health Care (DW, DL, LZ, DH, RH, LLF), Morrisville, NC.

Source of Funding: None.

Author Disclosures: Dr Foushee is part of the Carolina Consortium that received a Patient-Centered Outcomes Research Institute grant for a similar hypertension project, but under a different scope of pharmacist practice. The remaining authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (DW, DL, DH, RH, LLF); acquisition of data (DW, LZ); analysis and interpretation of data (DW, DL, LZ, DH, RH, LLF); drafting of the manuscript (DW, DL, DH, RH, LLF); critical revision of the manuscript for important intellectual content (DW, DL, DH, RH, LLF); statistical analysis (LZ); administrative, technical, or logistic support (DW, DL, DH, RH, LLF); project management support (DL); supervision of student projects to assist with background information (DH); and supervision (LLF).

Address Correspondence to: Daniel Wolverton, PharmD, BCPS, BCACP, BC-ADM, CPP, Managed Pharmacy Solutions, UNC Health Care System, 1025 Think Place, Ste 460, Mailbox 9, Morrisville, NC 27560. Email: Daniel.Wolverton@unchealth.unc.edu.

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